D3.451 - Long-term follow-up of ASA therapy after desensitization in patients with chronic rhinosinusitis with nasal polyps indicates high rate of treatment discontinuation

Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often present with hypersensitivity reactions to acetylsalicylic acid (ASA). ASA therapy after desensitization is a treatment method that aims to prevent the recurrence of nasal polyps in CRSwNP patients. The long-term outcomes of ASA therapy in those patients treated at our clinic are presented.

A total of 15 patients (11 male, 4 female, median age 48 years, range 22–63 years) with CRSwNP and confirmed ASA intolerance underwent ASA desensitization according to a 2-days desensitization protocol between 2014 and 2022 and have been followed up during subsequent ASA therapy. 

One patient was lost to follow-up. Only 3 out of the remaining 14 patients are continuing ASA treatment. The longest treatment duration among those who remain on ASA is 12 years. One of these patients remaining on ASA is concomitantly treated with dupilumab, and another patient stays on oral corticosteroids to maintain control of CRSwNP symptoms. Eleven out of 14 patients have discontinued ASA therapy. The median time to treatment discontinuation was 1 year (range 1 month – 7 years). The most common reasons for discontinuation were adverse effects in 5 cases (discontinuation between 1 month to 5 years from start) and lack of efficacy in 3 cases (discontinuation between 0.5 to 4 years). In 1 case, ASA therapy was switched to anti-IL-5 because of asthma worsening. In another case, discontinuation was the patient’s own decision after 1.5 years of treatment. In a further case, the patient had received ASA therapy for 7 years but after a temporary treatment interruption of 1-2 weeks developed anaphylaxis upon reintroduction of ASA, leading to treatment discontinuation.

ASA therapy after desensitization in patients with CRSwNP is associated with a high discontinuation rate, primarily due to adverse effects. This limits the usefulness of ASA therapy in CRSwNP patients, particularly as alternative treatments in the form of biologics have become available.